ST-elevation myocardial infarction (STEMI) remains a leading cause of global morbidity and mortality. While percutaneous coronary intervention (PCI) is the definitive reperfusion strategy, residual disease burden and plaque vulnerability both influence clinical recovery. The residual SYNTAX score (rSS) quantifies untreated macroscopic coronary artery disease, whereas optical coherence tomography (OCT) resolves microscopic plaque architecture, notably thin-cap fibroatheroma (TCFA). This pilot study explored the descriptive characteristics and short-term outcomes associated with combining rSS and OCT-derived TCFA in a highly selected STEMI cohort. This retrospective observational pilot study included 30 patients with STEMI who underwent primary PCI and culprit lesion OCT evaluation at a tertiary care center. Patients were stratified into four groups according to the presence of culprit TCFA and the post-PCI rSS threshold ( ≤ 4 vs. > 4): group 0 (TCFA absent, rSS > 4), group 1 (TCFA absent, rSS ≤ 4), group 2 (TCFA present, rSS > 4), and group 3 (TCFA present, rSS ≤ 4). The primary clinical endpoint was major adverse cardiac events (MACE)—a composite of all-cause death, recurrent myocardial infarction, target lesion revascularization, heart failure hospitalisation, and ischemic stroke—assessed over 3 months. The cohort (mean age, 54.5 ± 10.1 years; 83.3
Ascending aortic diameter guides intervention for thoracic aneurysms. Many patients with acute type A aortic dissection (ATAAD) present with ascending aortic diameters below 5.5 cm, rendering diameter an insufficient risk discriminator. This study evaluated computed tomography angiography (CTA) morphology to identify predissection radiographic features associated with ATAAD. Control (n = 50, CTA for non-aortic indications), aneurysm (n = 61, thoracic ascending aorta [TAA] ≥ 4.5 cm), and predissection (n = 13, CTA within 3 years before dissection) groups were studied. Scans were interpreted by thoracic radiologists using predefined measurements. Age and sex distribution differed overall among groups (P < 0.001 and P = 0.010, respectively). The aneurysm group was older than controls, but the age difference from the predissection group was not significant (P = 0.084). Maximum TAA diameter (MaxD) was 3.11 ± 0.30, 4.96 ± 0.52, and 3.89 ± 0.60 cm in control, aneurysm, and predissection groups respectively; all predissection MaxD values were below 5.5 cm (maximum, 4.9 cm). Ascending aortic length (AAL) was elevated in both disease groups (aneurysm group, 9.03 ± 1.08 cm; predissection group, 10.73 ± 1.41 cm; P < 0.001 vs. control group, 6.38 ± 0.75 cm). The AAL/MaxD ratio differed significantly between every pair of groups (control group, 2.06 ± 0.22; aneurysm group, 1.83 ± 0.21; predissection group, 2.80 ± 0.50; all pairwise P < 0.001), reflecting disproportionate elongation in predissection aortas. Aneurysm patients demonstrated diffuse thoracic dilation, whereas predissection group patients showed predominantly ascending aortic involvement. In a small exploratory study, predissection aortas displayed a distinct morphological phenotype characterized by disproportionate elongation, moderate dilation, and a relatively nondilated descending aorta—distinct from the diffuse dilation of aneurysm. Ascending aortic length and the AAL/MaxD ratio may provide complementary morphological information beyond maximal diameter alone.
